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Open Access The devil we know: is the use of injectable agents for the treatment of MDR-TB justified?

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For decades, second-line injectable agents (IAs) have been the cornerstone of treatment for multidrug-resistant tuberculosis (MDR-TB). Although evidence on the efficacy of IAs is limited, there is an expanding body of evidence on the serious adverse events caused by these drugs. Here, we present the results of a structured literature review of the safety and efficacy of IAs. We review the continued widespread use of these agents in the context of therapeutic alternatives—most notably the newer TB drugs, bedaquiline and delamanid—and from the context of human rights, ethics and patient-centered care. We conclude that there is limited evidence of the efficacy of IAs, clear evidence of the risks of these drugs, and that persons living with MDR-TB should be informed about these risks and provided with access to alternative therapeutic options.
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Keywords: MDR-TB; drug-resistant TB; hearing loss; injectable agents; ototoxicity

Document Type: Research Article

Affiliations: 1: Médecins Sans Frontières, Khayeltisha 2: TB Proof, Cape Town 3: Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa 4: Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa 5: Stop TB Partnership, Geneva, Switzerland 6: Desmond Tutu TB Center, Stellenbosch University, Cape Town, South Africa 7: Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts 8: HIV/TB Project, Treatment Action Group, New York, New York 9: Beth Israel-Deaconess Medical Center, Boston, Massachusetts, USA 10: Centre for International Health, Imperial College, London, UK 11: College of Liberal Arts and Sciences, Wayne State University, Detroit, Michigan, USA 12: TB Proof, Cape Town, Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa

Publication date: 01 November 2017

More about this publication?
  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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